Professor Muhammad Ali Pate is a global public health expert and a former minister of health. In this interview, he speaks on preparedness and response for infectious diseases, local vaccine production, health financing and policies among others.
As a global public health expert who is familiar with Nigeria’s primary healthcare system, what is your take on the country’s healthcare policies?
In the last few decades, Nigeria has put in place – on paper – very sound policies, legal frameworks and regulations and programmes.
These have ranged from the health reforms and National Health Policy in 2004 led by then Minister of Health Prof. Eyitayo Lambo, which 10 years later led to the enactment of the National Health Act (2014), creating the Basic Health Care Provision Fund (BHCPF), to the National Strategic Health Development Plan led by the late minister, Prof. Babatunde Osotimehin in 2009, to the States Health Investment Programme (NSHIP) Results-based financing in 2009, the Primary Health Care Under One Roof policy in 2010, Midwives Service Scheme, Saving One Million Lives (SOML Initiative), creation of the Presidential Task Force on Polio Eradication and PHC, National and State-level EOCs, and many other initiatives.
Some of these policies and initiatives have been successful and endured up till this day many years after they were developed.
The EOC mechanism created for polio became so vital in the fight against Ebola. The PTF first created for polio has today become the anchor for the fight against COVID-19.
Our challenge in Nigeria is not as much the sectoral level policy but has to do with the implementation and enforcement of regulations and standards.
If the health sectoral policies are implemented faithfully, with all the integrity required of all the actors, the results would be much better than they are today.
Like the rest of the world and Africa, Nigeria is affected by the COVID-19 pandemic. What is your assessment of its efforts in tackling the pandemic?
COVID-19 has demonstrated clearly why investing in the health sector is not a luxury or option. Public health security is vital to economic and national security.
While the pandemic’s devastating health impact in human lives lost in Nigeria has thankfully been relatively lower than other countries, the economic impact has affected almost everyone. The federal and state governments and the private sector have demonstrated a collaborative approach that is commendable.
But there is a need to continue to engage citizens in ways that will earn their trust to respect and comply with public health measures when necessary.
The public officials themselves can do better by being more transparent to the people, to dispel the perception that the COVID-19 response was mired by corrupt tendencies in some government agencies.
Africa as a region is yet to adopt a common approach to tackle pandemics as we have seen in its handling of COVID-19, Ebola and other threats.
Poor budgetary allocation to the health sector is an issue of concern in the country. What is the way out?
The issue of health financing is very important for any country. Not only the level of public financing available through the budget but also what the finance buys, that is, the quality of spending.
For adequate financing to be available, the government must be able to collect the tax revenues, which at this moment, Nigeria is among the lowest collectors relative to the size of our economy, due to leakages, exemptions, and perhaps also corruption.
While these are not in the health sector domain, they affect the total resources available to government to finance adequately health, education and other critical areas. To fix it, Nigeria must grow its economy and then collect more of the additional revenue to deploy to people-oriented sectors like health.
When our leaders go to Europe or UAE for medical tourism, they are taking the easy way out. Those countries collected more of their public revenues and invest those revenues in health.
You cannot spend to buy a bicycle and expect to ride a Mercedes car. To finance health, the government must collect the revenues or not leave the revenues to be drained by corruption or willful lack of compliance.
In terms of what is allocated to health, Nigeria spends slightly more than other African countries in health but achieves poorer population health outcomes compared to countries like Ghana, Ethiopia and Rwanda.
The most cost-effective interventions for population health are the essential services for everyone, the primary health care services – immunization, treatment of basic conditions like diarrhoea, malaria, pneumonia, care of pregnant women, newborns, children and adolescents, nutrition, sanitation and hygiene, as well as preventive care for non-communicable diseases like hypertension and diabetes.
Unfortunately, in some instances, the allocated funds end up financing redundant human resources, or big constructions and supplies because of the contracts and associated gratifications. So, we must closely monitor the quality of spending on health and reduce wastage to stretch the limited health budgets for more health.
In the face of emerging and re-emerging infectious diseases, do you think Nigeria and other African countries are prepared?
In the last 25 years, there has been a globally increasing spate of emerging and re-emerging infectious diseases. Partly because as the human population expands along with urbanization, we are encroaching on the natural ecology and encountering infectious agents in animal populations.
The interface of humans, animals and ecology is continuing, so we should expect periodically to see new zoonotic illnesses.
To contend with this situation, we must work harder to prevent spillovers in the first instance and have adequate prevention and preparedness measures.
This entails cooperation between human and animal health sectors, it requires building laboratory capacities, human resources and health infrastructure. It requires engaging citizens and communities through channels they trust.
These are the public health security investments that our governments should prioritize at country level and regional level. The wealthier countries are protecting themselves, and when the chips are down, we will discover we are on our own unless we invest in our health systems and public health.
There is a strong advocacy for local vaccine production in Africa. How can Nigeria build capacity and lead the way?
There is an economic value chain in health, including the manufacturing of pharmaceuticals for local diseases, and biologicals such as vaccines.
But to be able to manufacture successfully, the enabling environment must be there, such as appropriate regulation, ease of doing business, quality human resources, patient capital and strong intellectual property protection laws.
Without strong National Agency for Food and Drug Administration and Control (NAFDAC), and all those enablers, including investing in science and technology, my view is that we could miss an important opportunity to accelerate medical industrialisation in Nigeria and its attendant economic benefits.
It is not accidental that India is where it is in pharmaceutical and vaccines production, or that the major manufacturers are in a few countries. With Nigeria’s 212 million estimated population, we have the demand base, and medical industrialisation can be made a reality, with the appropriate government leadership.
What is the way out?
The way out is to invest properly and prudently in the public health systems to guarantee basic health care to all Nigerians, including the poorest and most vulnerable, and to regulate and mobilize private sector capacities and capital to develop world-class private sector facilities for those willing to pay the premium.
